Eye alignment

Hello,

I am a 25 yr old female w/ no family history of eye problems. I do work with computers ALOT though (since 19), and for the last couple of years I've been having problems with eye strain, where i keep getting headaches and my eyes get very tired, but I didn't look into it much.

Fastforward to the present, I have gotten 2 comments from people close to me that I have a lazy eye. I found this weird since I have always had perfect vision (but I havn't been to the eye doctor in years).

I've noticed that my left eye is dominant eye,but it is also the most tired latey. Also, looking in the mirror, my right and left eye seem the slightly askew, but nothing that stands out. So finally i decided to see for myself, and I took a picture of my eyes looking at my finger very close to my nose, and i saw that my left eye turned in toward my finger, but the right eye basically just stayed straight. What does this mean? Is this just eyestrain or could i be developing lazyy eye as an adult? I'm planning to see an eye doctor within the next few weeks...do you have any insight in how to make the most of my visit, and do you think this might be fixable? Thanks!

[John C Hagan III, MD, FACS, FAAO]

At age 25 you're not likely to develop eye alignment problems. More likely you've had the problem and, perhaps because of stress or fatigue, your control is breaking and the latent misalignment is becoming manifest.

Crossed eyes or esotrophia is usually very noticible and is often associated with reduced or poor vision in one eye (amblyopia). That is the true definition of amblyopia or 'lazy eye'.  However many people incorrectly use the term to describe a droopy eyelid (ptosis) or an eye that occassionaly wanders outward sometimes (intermittent exotrophia) or all the time ('wall eyes or exotrophia') . In any case people with crossed eyes 'know it'.

Thus the ophthalmologist is likely to tell you your problem is an eye muscle disorder called intetmittent exotrophia. This often runs in families so check with your family historian to see if anyone else in the blood line has had eye muscle problems. You might look at some old pictures of yourself to see if you can detect the wandering eye in any of them. If you can take them to your eye examination.

You might ask your family and friends if they ever noticed that one eye was turning out. Also have you noted in the past that when you talk to someone they look over the shoulder to see what your wandering eye is looking at (a certain giveaway that the eyes aren't straight).

Treatment is often difficult as an adult, sometimes it's to try and avoid those things that make it flip out (fatigue, alcohol, bright lights). Fusion exercises are sometimes used but not very successful in my experience. In situations where the condition is detoriorating and the eye is 'out' more than 50% of the time eye muscle surgery is sometimes indicated.

This should be evaluated by an ophthalmologist (EyeMD) and if available a pediatric ophthalmologist that does adult strabismus (eye alignment disorders)---most do.


JCH MD

[Sanaasol]

Thank you for the reply.

I will continue to look through childhood pictures. I've asked many family members since, and they insist they never noticed anything, and that they don't think anything like this runs in the family, but who knows?

Also, I did fall down the steps and hit the back of my head relatively hard a few weeks ago, do you think this could have anything to do with it? Should I mention this to the doctor, or would this be silly?  Thanks again!

[EyeForumMD]

It's very unlikely that the fall caused the problem. If it would make you feel better you can certainly tell your ophthalmologist.

One of the reasons to think you've had this for quite a while is that if did just happen then when your eye "turned out" you would have visually distrubing true crossed double vision. That other's notice your eye turn out and you can't tell it and don't have double vision indicates your brain has made adjustments for a long time to suppress the central vision from the eye not pointed in the right direction.

JCH MD

[Sanaasol]

That makes alot of sense. Thanks for your help.